Study of choice between accident and emergency departments and general practice centres for out of hours primary care problems

Abstract

Objectives-To determine the reasons for choosing between primary care out of hours centres and accident and emergency (A&E) departments for patients with primary care problems. Methods-Interviews using a semistructured approach of samples of patients attending A&E departments and general practitioner (GP) out of hours centres for primary care problems. Results-102 patient interviews were undertaken. Sixty two per cent of A&E attenders were unemployed compared with 41% of out of hours attenders. White people were more likely to attend A&E departments and Asians the out of hours centre (p<0.01) and unemployed were more likely to attend A&E departments (70% v 30%). Some 46.3% of A&E department attenders had not contacted their GP before attending; 81.3% of first time users of the out of hours centre found out about it on the day of interview. Those attending A&E thought waiting times at the out of hours centre would be 6.3 hours (median) compared with a median perceived time of 2.9 hours by those actually attending the out of hours centre. Actual time was actually much less. Conclusion-Once patients have used the GP out of hours centre they are more likely to use it again. Education should be targeted at young adults, the unemployed and white people. Patients should be encouraged to contact their GP before A&E department attendance for non-life threatening conditions. Waiting time perception may be an important reason for choice of service. (J Accid Emerg Med 2000;17:18-21) Keywords: out of hours care; primary care; patient choice General practice cooperatives are a comparatively new and successful provision of out of hours primary care in the United Kingdom. In these cooperatives groups of general practitioners (GPs) combine resources to provide emergency cover for their practices. Out of hours they usually run an emergency centre. Patients who telephone the GPs may be given advice, advised to attend the centre, or may receive a visit. However, patients continue to attend the accident and emergency (A&E) department with primary care problems out of hours. As primary care attenders to the A&E department can be managed more appropriately and more economically by the GP services, 1 the current state of aVairs represents a poor use of resources.Factors that have been shown to determine why patients choose A&E over general practice are travelling distance, 2 lack of knowledge of the range of GP services, 3 perceived need for immediate attention, 4 and more advanced technology. 5A small proportion of these patients are not registered with a GP, are visitors, or are homeless. 6 These results are from studies that were conducted before the inception of out of hours GP cooperatives, when GP deputising services were the mainstay of out of hours primary care. No study to date has determined the reasons for out of Figure 1 The age distribution of A&E and cooperative patients.

Inappropriate use of emergency services: a systematic review of prevalence and associated factors

“…Only two studies 40,43 failed to show this association. In the first, the study population consisted of adults 65 years or older; the second, in addition to only comparing mean age in two groups, showed a lower score based on the Downs & Black criteria.…”

“…Five studies examined race or skin color, but since they categorized it differently it was impossible to summarize the results 13,25,30,34,43 .…”

“…Among those not showing an association with gender 12,16,19,23,31,32,40,43 , five 16,19,23,31,43 only performed univariate analysis and/or showed a low score according to Downs & Black criteria and Finn et al only studied individuals 65 years or older 40 . Two other studies that did not show an association with gender were case-controls; however, they compared populations with similar health problems that chose to go to the ED or to the outpatient department, while the others compared individuals with inappropriate versus appropriate ED use 12,32 .…”

“…The four descriptive studies that evaluated the access-related reasons for preferring the ED detected difficulties in consulting primary care, such as the primary care facility being closed, difficulty in obtaining an appointment, and waiting time as reasons for inappropriate ED use 12,13,16,21,32,35,43 . Lee et al 32 and Rajpar et al 43 found that 35% and 50% of patients, respectively, reported closed primary care facilities as one of the reasons for inappropriate ED use, but in the latter 46.3% had not even attempted contact with primary care.…”

Primary care presentations at emergency departments: rates and reasons by age and sex

“…As a result of well publicised problems of access to care in emergency departments 1,2 they have been perceived as an issue for concern in ED management not only in Australia but in places as disparate as Canada, 3 Spain, 4 Britain, [5][6][7][8] France, 9 Holland, 10 New Zealand 11 and many others. 12,13 A recent study focussed on the reasons that "potential primary care" (PPC) patients give for presenting to EDs rather than to general practitioners.…”